Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate Professor Chiara Bucciarelli-Ducci, Royal Brompton and Harefield Hospitals, UK
- Second opponent: Senior consultant Niels Risum, Copenhagen University Hospital Rigshospitalet, Denmark
- Third member and chair of the evaluation committee: Professor II Anne Negård, University of Oslo
Chair of the Defence
Professor II Theis Tønnessen, University of Oslo
Principal Supervisor
Einar Hopp, Oslo University Hospital
Summary
Left bundle branch block (LBBB) causes dyssynchronous contractions of the left ventricle, which negatively alters its function. Typically, there is reduced function of the interventricular septum and compensatory increased workload on the left ventricular (LV) lateral wall. Cardiac resynchronization therapy (CRT) restores septal function, and thereby improves global LV function, in many patients with heart failure and LBBB. Still, about one third of patients do not benefit from the therapy.
The aim of the present thesis was to study the potential role of cardiac magnetic resonance (CMR) in LV dyssynchrony and its relation to CRT response. We included patients referred for CRT in a prospective, multicenter study.
In study 1, we demonstrated the feasibility of a new method to demonstrate LV dyssynchrony by calculating regional myocardial work in LBBB using CMR and non-invasive LV pressure. This method could be a valuable alternative to work estimates from echocardiography.
In study 2, we explored if echocardiography and nuclear imaging (PET) can identify LV scar in dyssynchronous ventricles. CMR was used as gold standard for scar. We found that PET is a good alternative to CMR to identify transmural LV lateral wall scar, while neither PET nor echocardiography identified septal scar. Hence, CMR is needed to assess scar in septum.
In study 3, we found that CMR, by assessing both septal scar and LV dyssynchrony, predicted CRT response with added value to current CRT selection criteria. Based on these findings, we advocate increased priority for CMR in patients referred for CRT.
Additional information
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